Well it is official! I have opened my own office in Sand Springs. I have manage to find a couple of amazing doctors who are backing and helping me in opening this space.

I am taking over an existing clinic from Dr. Brandi Wilcox who is looking to reopen closer to her home. The new clinic is Wilcox Chiropractic which will be renamed Sand Springs Chiropractic sometime in the next year or so.

I invite everyone to come over, say hi, and check out the new space. I hope to see you soon!

Spinal manipulation or physical therapy such as heat and stretches (above) seem as effective as traditional approaches to help lower back pain. Credit Joshua Bright for The New York Times

About two of every three people will probably experience significant low back pain at some point. A physician like me might suggest any number of potential treatments and therapies. But one I never considered was a referral for spinal manipulation.

It appears I may have been mistaken. For initial treatment of lower back pain, it may be time for me (and other physicians) to rethink our biases.

Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer.

Most back pain resolves over time, so interventions that focus on relief of symptoms and allow the body to heal are ideal. Many of these can be nonpharmacological in nature, like the work done by chiropractors or physical therapists.

Physicians are traditionally wary of spinal manipulation (applying pressure on bones and joints), in part because the practitioners are often not doctors and also because a few chiropractors have claimed they can address conditions that have little to do with the spine. Patients with back pain haven’t seemed as skeptical. A large survey of them from 2002 through 2008 found that more than 30 percent sought chiropractic care, significantly more than those who sought massage, acupuncture or homeopathy.

Researchers have been looking at the evidence supporting spinal manipulation for some time. Almost 35 years ago, a systematic review evaluated the available research, most of which was judged to be low in quality, and found that there might be some short-term benefits from the procedure. Two reviews from 2003 agreed for the most part, finding that spinal manipulation worked better than a “sham procedure”, or placebo, but no better or worse than other options.

Almost a decade later, a Cochrane review assessed the literature once more, and found 12 new trials had been conducted. This review was more damning. It found that spinal manipulation was no better than sham interventions.

But since then, data have accumulated, as more higher-quality studies have been performed. Recently, in The Journal of the American Medical Association, researchers looked for new studies since 2011, as well as those that had been performed before.

The evidence from 15 randomized controlled trials, which included more than 1,700 patients, showed that spinal manipulation caused an improvement in pain of about 10 points on a 100-point scale. The evidence from 12 randomized controlled trials — which overlapped, but not completely with the other trials — of almost 1,400 patients showed that spinal manipulation also resulted in improvements in function.

In February, in Annals of Internal Medicine, another systematic review of nonpharmacologic therapies generally agreed with the other recent trials. Based upon this review, and other evidence, the American College of Physicians released new clinical practice guidelines for the noninvasive treatment of subacute back pain. They recommended that patients should try heat, massage, acupuncture or spinal manipulation as first-line therapies.

The only things that might detract from the use of spinal manipulation in this situation would be its cost and potential harms.

Because they fear those potential harms, some physicians are hesitant to refer patients to chiropractors or physical therapists for care. But in all the studies summarized above, there were really no serious adverse events reported. It’s possible to find anecdotes of harm to the spinal cord from improper manipulations, but these are rare, and almost never involve the lower spine.

Some physicians are concerned about the cost of spinal manipulation, especially since most insurance carriers don’t cover it. Visiting a chiropractor costs more than taking many non-narcotic pain medications. But more invasive interventions can cost a lot of money. In addition, studies have shown that, in general, users of complementary and alternative medicine spend less over all for back pain than users of only traditional medicine.

Medication and surgery can also lead to harms. We shouldn’t forget that prescription pain medications, like opioids, can lead to huge costs, especially when they’re misused.

Some physicians are uncomfortable that we don’t have a clear picture of how spinal manipulation actually works to reduce pain. It’s also possible that some chiropractors do it “better” than others, and we can’t tell. This concern should be tempered by the fact that we don’t have a great understanding of why many other therapies work either. Some of the more traditional things we recommend don’t even work consistently.

But given the natural course of back pain — that most of it goes away no matter what you do — the ideal approach is to treat the symptoms and let the body heal. Noninvasive therapies seem to do that well enough.

After a ride on your bike, have you experienced numbness, tingling, or pain in your arm, hand, wrist, or little finger? If you have, you could be suffering from an overuse injury. Approximately one-third of all bicycling overuse injuries involves the hands. The 2 most common are what we call “handlebar palsy” and carpal tunnel syndrome. By making some adjustments to your bike, posture, and by wearing some protective equipment, you can prevent these injuries from occurring.

Handlebar palsy

Ulnar neuropathy, known to cyclists as handlebar palsy, is caused by compression of the ulnar nerve at the hand and wrist. The ulnar nerve controls sensation in your ring and little finger and controls most of the muscular function of your hand. Compression of the ulnar nerve is a common problem for competitive and recreational cycle enthusiasts, alike. Compression is the result of direct pressure on the ulnar nerve from the grip on the handlebars. Often, the nerve may be over stretched or hyperextended (extension beyond its normal limit) when a drop-down handlebar is held in the lower position. The pressure placed on the ulnar nerve results in numbness and tingling in the ring and little fingers or hand weakness, or a combination of both. Symptoms can take from several days to months to resolve, but surgical treatment is rarely necessary. Rest, stretching exercises, and anti-inflammatory medications, such as aspirin, usually help relieve the symptoms. Applying less pressure or weight to the handlebars and avoiding hyperextension can help to prevent a recurrence.

Carpal tunnel syndrome

Although it is less common than handlebar palsy, carpal tunnel syndrome (compression of the median nerve at the wrist) is another overuse injury that cyclists often experience. Injury often occurs when a cyclist holds the handlebars on top and applies pressure directly on the median nerve. Symptoms include numbness and tingling in the thumb, index, middle, and ring fingers and weakness of the hand. Symptoms usually resolve quickly once you stop cycling for a short period of time. Although handlebar pressure contributes to these symptoms, there can be other causes for hand pain and numbness; therefore, an evaluation for other possible causes of carpal tunnel syndrome should be performed by your health-care professional.

Prevention with Equipment

Adjust your handlebars, seat and pedals to best suit your body and allow you to sit in a more upright position. Sitting upright will take the weight and pressure off of your hands and wrists. Wearing padded gloves may also reduce shocks and jolts to your body, which travel into your wrist joints from the road and can lead to pain.

The Correct Position for the Wrist

The carpel tunnel is a small gap between the many small wrist bones and a flat ligament at the base of the wrist. Ten tendons go through this small tunnel and are responsible for flexing the hand and fingers. A nerve also passes through this tunnel. Degeneration or mechanical stress can easily injure these small tissues resulting in a loss of function of the hand.

Riding with the wrist flexed like this stresses these small tissues:

I see this position quite often when I conduct rider assessments.

This hand position can lead to injury for two reasons:

The tendons are stretched to near full length.

Vibration or impact from the front wheel, such as a bump in the road, can then cause a trauma as the wrist is forced to extend too far.

The correct position is with the wrist straight like this:

This position allows shock to travel up the arm while supported by the bones and cartilage, which are much stronger tissues than the fine tendons and ligaments supporting the fingers.

Assess and Control Weak Wrist Flexors

One reason we ride incorrectly is simply due to lack of knowledge or bad habits. But another reason can be weak wrist flexors. If you are a regular gym-goer, there are some tests you can do with pressing exercises to assess and control these flexors.

To conduct the test of your hand position you will need a set of grips, a suspension trainer, or a set of rings. You are going to check for correct wrist alignment while you perform a push up on this gear.

Correct wrist position:

Incorrect wrist position:

Elbow Position Is Important, Too

Avoiding injury doesn’t end at hand position, though. Should you hit a large bump in the road, and you manage to avoid wrist injury, the shock will continue to travel up the arm to the elbow. This is the second potential area of injury due to incorrect position.

Elbows should be slightly flexed like the cyclist shown here:

This allows any movement of the handlebars to be taken up by the elbow flexing. If you ride with your elbows stiff or locked, then vibration and shocks may extend the elbow too far and lead to trauma.

So please remember to keep your wrists straight and elbows flexed when out on the bike.

Last Friday and Saturday was the Grand Opening at Tulsa Chiropractic Associates. It was a great success! We had a lot of people drop by, get tours of the office and check out all our modalities, all the kids had fun with the balloon guy and the bounce house, the food was good, and I got to be live on the radio! I just wanted to thank everyone who came out and supported us. I can't wait to see you again soon!